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TANK CLOSURE CFR7FICA7ICN FORM <br /> BUSINESS NAME <br /> The Port of Stockton ICA <br /> 3I7@ :.uCR€S.i <br /> 2201 W. Washington St . <br /> ' <br /> �US'NE„,..7Y .CS aUSaN€55 a7 "J6 <br /> 9201 <br /> tocAlono CA 500 <br /> i <br /> TANK C,WNFR NAME <br /> The Port of Stockton <br /> i <br /> TANK ZWNFR ACCRESS i0i <br /> 2201 W. Washington St . <br /> TANK::vNER G:tY St>;L 5'ATe 505 :;R =4+ <br /> Stockton , CA 9:. 201 <br /> TANK C' n IRF= I F, 0 rt <br /> =tQW oxygen <br /> TanK Flammacie`lanor ter <br /> (State Tank IC*,if applicable) Teo Canter Bottom Top ranter k Ban= <br /> Tank Interior <br /> Atmosphere � / <br /> Readings 67 <br /> On examination of the tank.1 certify ank is vi tree om product.sludge. scale(thin.9aky residual of tanK cantemS},rinseate and deflns. I further certfy <br /> that the nfermation provided h + t <br /> er ru rid ac rale he best of my Knowledge. i <br /> GERTIFSER SIGNAT„R <br /> STA T LS OR AFrILIATICN rF CERTIF-!ING-ERSCN SEs <br /> CERT,IFIER NAME(PRi[NT) sob Richard 'Thor Certifier is a representative of;he CiJPAIL:A: YES C1 NO <br /> CER-MER TITLE soy <br /> Contractor Name of CuPAlL!A <br /> ACCRESS P.O. oX 55 If cerifier s other than CUPA!'L:A=eck approcnate box beiaw: <br /> CITY Lodi. , T7324T-- <br /> ❑ Certified Industral Hygienist(CIH} <br /> PHONE (209)3G8-617o <br /> Da T E CERTIFIED 5u CRTIFICATICN TIME ❑ Cartified Safety Professional(CSP) <br /> certified Menne Chemist IC-MC) <br /> 1 /4/99 1 PM <br /> ❑ Registered Environmental Health Specialist(Re=1S) <br /> ❑ Professional Engineer(PE) <br /> e <br /> Q Crass it Registered Environmental Assessor <br /> CSLB licensed GntraCtor(with hazardous substance oenific3te) <br /> ® Yes C: No his;anK previously held`lammaoie or combustible materials. if yes.She tank interior atmosphere shall be 7E C`S@C%ed wttSt a mCUsi7t]le gas <br /> indicator prior to work being conducted on the tank. <br /> Cartiners tank management instructions far soap dealer.disposal t tiny, etc_ <br /> A copy of this certificate shall accombany the tank to the recyc!ing disposal faaiity. I <br />